| NPI | 1174582522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 0023225) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 009002) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2007-08-15 |