| NPI | 1437502184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SD D1333) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1001391) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2021-11-22 |