| NPI | 1194856955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D9694) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ D7174) |
| 1223G0001X Dentist General Practice (Licence: WA DE00010805) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2020-06-18 |