| NPI | 1104862275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 4931937-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 4931937-8903) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2007-07-08 |