| NPI | 1245207471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 8317) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3574) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2013-05-17 |