| NPI | 1508928169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 10507) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 142369-9922) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2019-12-20 |