| NPI | 1245295302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D009942) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D009942) |
| 1223G0001X Dentist, General Practice (Licence: GA DN123629) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2024-11-21 |