| NPI | 1841688033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 10227) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 8230) |
| Enumeration Date | 2014-12-23 |
| Last Update Date | 2021-11-29 |