| NPI | 1437109840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3996) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 3996) |
| 122300000X Dentist (Licence: GA 10614) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2017-05-05 |