| NPI | 1245496512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 08700) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 6754) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2012-04-10 |