| NPI | 1407340284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D011163) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 33813) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2021-08-10 |