| NPI | 1871943332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 10881) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D009476) |
| 1223G0001X Dentist, General Practice (Licence: NC 10881) | |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2021-09-20 |