| NPI | 1114257672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 25341) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ D7920) |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2022-02-07 |