| NPI | 1497067722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 1002054) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D12788) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2023-12-13 |