| NPI | 1245496504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AZ D009862) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD3945) |
| 1223G0001X Dentist General Practice (Licence: NM DD3945) | |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2020-09-16 |