| NPI | 1033131834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 3272-015) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 0003272015) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2014-05-15 |