| NPI | 1326229337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 10155765-9924) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 101557659923) |
| 1223G0001X Dentist, General Practice (Licence: ID D-4041) | |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2024-10-23 |