| NPI | 1902219215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NH 04072) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS039866) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2018-01-19 |