| NPI | 1124266887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AL 5790 C1) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MS 3371-06) |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2010-07-26 |