| NPI | 1992119184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 9052001-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 9052001-9921) |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2020-08-11 |