| NPI | 1376668715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 4070-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN 4070) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2011-04-04 |