| NPI | 1750721387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AZ D009088) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 9088) |
| 1223G0001X Dentist General Practice (Licence: KS 61002) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2015-10-19 |