| NPI | 1235417163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WY 1292) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 6979) |
| 122300000X Dentist (Licence: UT 9197972-9921) | |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2015-12-23 |