| NPI | 1265570097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 8938) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 008938) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2015-10-30 |