| NPI | 1013982461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 143285-9921) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NE 6524) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2007-07-08 |