| NPI | 1093164980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D009464) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ D9464) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2021-01-11 |