| NPI | 1164406443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 9806) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 20664) |
| 122300000X Dentist (Licence: CT 009806) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2014-04-15 |