| NPI | 1932548799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NM DD4483) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ D008736) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2016-08-08 |