| NPI | 1376509083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3147) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN013162) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401411212) | |
| 1223G0001X Dentist, General Practice (Licence: MA 21298) | |
| 1223G0001X Dentist, General Practice (Licence: NY 052536) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2007-07-09 |