| NPI | 1194807156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 5314850-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK DEND1161) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2023-05-24 |