| NPI | 1427059666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 7115) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 8559) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2013-10-10 |