| NPI | 1558357020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6171-015) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 07543) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2023-03-07 |