| NPI | 1063558021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 8926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3048) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2013-10-28 |