| NPI | 1881897262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 21805) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 22983) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2022-09-09 |