| NPI | 1922160209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2006014152) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4065) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2018-08-13 |