| NPI | 1285839761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 5537) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL Pending) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2015-04-13 |