| NPI | 1912288911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WI 6791-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6791-15) |
| 1223G0001X Dentist General Practice (Licence: WI 6791-015) | |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2020-10-23 |