| NPI | 1053547166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 4578) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 8702) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2009-06-03 |