| NPI | 1972794030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 6592134-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D07533) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2022-03-02 |