| NPI | 1932378890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 4168-20) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA LA3197) |
| 1223G0001X Dentist, General Practice (Licence: AR 3890) | |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2020-10-27 |