| NPI | 1912153362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 9851) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 7549) |
| 1223G0001X Dentist, General Practice (Licence: AZ D7549) | |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2021-06-16 |