| NPI | 1457335184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 10872) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 2796) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2018-03-17 |