| NPI | 1184834384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS020304L) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL dn8554) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2010-04-29 |