| NPI | 1356577514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 4595) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 3962) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2016-08-03 |