| NPI | 1992171888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VI 1744) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 9168) |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2015-08-14 |