| NPI | 1225133234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 7530) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VT 016-0000627) |
| 1223G0001X Dentist, General Practice (Licence: PA DS035247) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-08 |