| NPI | 1235238254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D009207) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 6439) |
| 1223G0001X Dentist, General Practice (Licence: GA DN014177) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2020-09-11 |