| NPI | 1417099334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 7151) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 7151) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2023-11-09 |