| NPI | 1801023478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D-4220) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D4220) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2018-12-10 |