| NPI | 1528251105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 5121811-9922) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ 6027) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2022-07-21 |