| NPI | 1477554483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D008361) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D 6829) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2015-12-18 |