| NPI | 1811396708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 13986) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID 4634) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2018-03-17 |