| NPI | 1467608505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 7569) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D07569) |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2025-05-20 |