| NPI | 1881709681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8717) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 2479) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2020-10-22 |