| NPI | 1083062780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D009703) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2016017466) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2017-06-13 |