| NPI | 1154515062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 8488) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 17941) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2013-10-02 |