| NPI | 1407886310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NH 03648) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21042) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2010-11-19 |