| NPI | 1255419446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013382) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901019341) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2010-09-24 |