| NPI | 1700235116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1001331-15) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 1001331) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2018-07-26 |