| NPI | 1417327198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD4415) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1857058) |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2015-10-06 |