| NPI | 1952781924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 10820) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 8547) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2019-03-07 |