| NPI | 1447371869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11147) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ DO7002) |
| 1223G0001X Dentist, General Practice (Licence: AZ 7002) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2022-07-21 |