| NPI | 1710096706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D6672) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 12754) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2011-06-08 |