| NPI | 1902189988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 4230) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 27461) |
| 1223G0001X Dentist, General Practice (Licence: LA 6923) | |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2018-09-22 |