| NPI | 1104233998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401417775) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 8982) |
| 1223G0001X Dentist, General Practice (Licence: TX 30901) | |
| 1223G0001X Dentist, General Practice (Licence: AZ 8982) | |
| 1223G0001X Dentist, General Practice (Licence: MD 16102) | |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2022-07-07 |