| NPI | 1982744306 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9089) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 6481) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2019-03-07 |