| NPI | 1750511192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD4329) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 7831) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2016-04-20 |