| NPI | 1235126707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PR 2107) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: PR 2107) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2016-08-24 |