| NPI | 1437367695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D8737) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 0026136) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2013-05-13 |