| NPI | 1336329887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 009938) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NH 03619) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2010-03-04 |