| NPI | 1124278858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D4194) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7078744-9922) |
| 1223G0001X Dentist, General Practice (Licence: WA DE60035255) | |
| 1223G0001X Dentist, General Practice (Licence: AZ 7620) | |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2020-04-08 |