| NPI | 1992839435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D008349) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9250) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2013-04-03 |