| NPI | 1295870442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 7841) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 7841) |
| 122300000X Dentist (Licence: IA 08330) | |
| 122300000X Dentist (Licence: IA 8012) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2020-04-09 |