| NPI | 1881012169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-09365) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM D4116) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2023-04-27 |