| NPI | 1134300569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3620-11) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN013045) |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2014-03-17 |