| NPI | 1588669196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 1471) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-021164) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2021-06-15 |