| NPI | 1881122091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 1626) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1001534-15) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2024-06-13 |