| NPI | 1861891475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401415210) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6504) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2021-03-07 |