| NPI | 1689820144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D07627) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 7627) |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2016-03-10 |