| NPI | 1942464078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 6977043-9923) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: UT 6977043) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2020-04-15 |