| NPI | 1427337732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AK DEND1390) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 25644) |
| 122300000X Dentist (Licence: AK 1390) | |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2022-07-20 |