| NPI | 1750403929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D011005) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 6634) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2022-12-02 |