| NPI | 1003974825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 4698) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: KY 4698) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2008-01-23 |