| NPI | 1891020806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11043) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 7884) |
| 122300000X Dentist (Licence: CO 10249) | |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2020-01-06 |