| NPI | 1033271804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 4414) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 4690) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2012-04-05 |