| NPI | 1396870861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM dd3377) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD1580) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2018-06-12 |