| NPI | 1184663718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D8859) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D3831) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2013-06-04 |