| NPI | 1952489908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D10584) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 5231) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-03-07 |