| NPI | 1407176704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WV 4197) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D9583) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2018-02-01 |