| NPI | 1417366261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 7352) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 30249) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2020-07-07 |