| NPI | 1720249337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4155) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7397758-9923) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2015-05-25 |