| NPI | 1437202181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D7304) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI 1266) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2014-09-15 |