| NPI | 1619328903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D009527) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4889) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2023-08-24 |