| NPI | 1972598902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 856) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 6622) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2024-10-01 |