| NPI | 1437156106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 5628) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D5628) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2024-04-12 |