| NPI | 1689762460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ AZ5859) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 5859) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2024-01-18 |