| NPI | 1891214029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN1001766) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 16427) |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2019-02-11 |