| NPI | 1528551603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D010629) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 108466489922) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2020-05-06 |