| NPI | 1912919432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D09182) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9885) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2019-09-17 |