| NPI | 1841494119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4052) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D4052) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2024-09-18 |