| NPI | 1487132320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 12771) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 34472) |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2020-07-02 |