| NPI | 1851312250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MN D12465) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ D6954) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2018-03-17 |