| NPI | 1720081334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AZ 5092) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9982) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2013-12-19 |