| NPI | 1245635051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D009381) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4156) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2016-10-20 |