| NPI | 1154529121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2242) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT 2242) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2018-06-16 |