| NPI | 1578171948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D010773) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ PD0027) |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2020-07-22 |