| NPI | 1689746232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D05019) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 09846) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2019-08-07 |