| NPI | 1518195056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D7764) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7369645-9921) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2009-06-23 |