| NPI | 1851834964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9142) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 100373) |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2018-12-27 |