| NPI | 1881975464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 10740332) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AK 1347) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2019-09-04 |