| NPI | 1396004446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 11069) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 60781) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2013-10-23 |