| NPI | 1316989411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 2061) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 8825) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2007-07-09 |