| NPI | 1922366038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO 202109) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IA 08912) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2018-05-29 |