| NPI | 1619973401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-5262) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 45619) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2021-09-23 |