| NPI | 1912270786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 12227007-9924) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 10760) |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2021-08-05 |