| NPI | 1669699484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D010949) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 0010542) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.025321) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2021-07-09 |