| NPI | 1447659644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1000990-015) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1000990-15) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2023-10-26 |