| NPI | 1841492063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SD DO614) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SD D0614) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2023-01-25 |