| NPI | 1437147410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 5821) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD2209) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2015-04-15 |