| NPI | 1376657619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ AZ3760) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ AZ 3760) |
| 1223G0001X Dentist General Practice (Licence: AZ AZ3760) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2009-06-08 |