| NPI | 1336228451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 7112) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34571) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2019-06-11 |