| NPI | 1225040116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 5765733-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D8256) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2012-09-07 |