| NPI | 1023423258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 9361973-9923) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D4591) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2022-06-07 |