| NPI | 1417202599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D008512) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D008512) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2017-11-13 |