| NPI | 1679615041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 6208) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 06208) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2019-12-19 |