| NPI | 1083863237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 300069) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS027508L) |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2014-08-07 |