| NPI | 1952306813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 8021) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WY 1595) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2021-10-26 |