| NPI | 1396909347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D4164) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7022232-9922) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2017-08-10 |