| NPI | 1437292463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 24363) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ 4964) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2018-11-05 |