| NPI | 1033352281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 7724) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 8222) |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2010-03-11 |