| NPI | 1225327281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 7987460-9921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D008150) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2014-12-02 |