| NPI | 1891313300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AZ D010774) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ PD0023) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2020-07-22 |