| NPI | 1053303966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3655) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 2435) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2008-07-01 |