| NPI | 1194958694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 7383546-9923) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7383546-9922) |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2022-08-02 |