| NPI | 1124034251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D008607) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-3383) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2015-06-25 |