| NPI | 1013261080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 010874) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 10874) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2013-01-02 |