| NPI | 1013064286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 8178) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS-026868-L) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2014-09-08 |