| NPI | 1932321130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D009597) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D8308) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2017-12-08 |