| NPI | 1346539228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 0116) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 8285) |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2013-05-30 |