| NPI | 1043284888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 3919) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 4855) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2013-06-07 |