| NPI | 1841586641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 6192) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 10795) |
| 1223G0001X Dentist, General Practice (Licence: TX 35920) | |
| 1223G0001X Dentist, General Practice (Licence: IN 12013882A) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2022-07-19 |