| NPI | 1033235734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D8208) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN012413) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2011-10-19 |