| NPI | 1053488429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23015) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 4842) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2021-02-24 |