| NPI | 1144412180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM dd4215) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D4091) |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2021-04-14 |