| NPI | 1336369073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6263-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 21644) |
| 122300000X Dentist (Licence: WI 6263-015) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2011-10-04 |