| NPI | 1154581262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 7023657-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7023657) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2013-04-22 |