| NPI | 1326245671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AZ D011216) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 43535) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2022-03-22 |