| NPI | 1326052523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 5037) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: KY 5307) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2010-12-10 |