| NPI | 1952613614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9860) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 853) |
| 1223G0001X Dentist, General Practice (Licence: SC 7005) | |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2016-05-13 |