| NPI | 1457344566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 358375-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9149) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2012-10-24 |