| NPI | 1912195462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D7462) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD3476) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2012-03-21 |