| NPI | 1861400228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ AZ4324) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D04324) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2020-06-16 |