| NPI | 1598217069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 4220) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 32517) |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2017-11-29 |