| NPI | 1942823182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D011111) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.026113) |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2021-08-05 |