| NPI | 1619050366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 6090) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC DEN 5601) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2016-09-15 |