| NPI | 1982981692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 7281) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 08887) |
| Enumeration Date | 2011-11-09 |
| Last Update Date | 2024-03-26 |