| NPI | 1063500643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 5499) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 53662) |
| 1223G0001X Dentist, General Practice (Licence: KY 8294) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2017-06-01 |