| NPI | 1063511558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KY 5371) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 5371) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2015-01-20 |