| NPI | 1972885200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D-5101) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ D008311) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2020-01-28 |