| NPI | 1881886059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D9403) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 7335) |
| 1223G0001X Dentist, General Practice (Licence: OR D9403) | |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2020-12-16 |