| NPI | 1316947690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5426-015) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 6010) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2013-01-02 |