| NPI | 1598287484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D10680) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 36616) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2020-09-23 |