| NPI | 1134215122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NM DD2803) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401410394) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2023-10-13 |