| NPI | 1649354564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D012199) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 4672) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401415484) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2024-07-09 |