| NPI | 1346308541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D008196) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 23024) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2015-10-16 |