| NPI | 1114083789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2008034527) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 378878-9922) |
| 1223G0001X Dentist, General Practice (Licence: CO 8900) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2009-01-09 |