| NPI | 1891852943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 11635) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 6013) |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2023-06-08 |