| NPI | 1225268584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 9880) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 58015) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2009-07-21 |