| NPI | 1467607382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD3421) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 7670) |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2011-01-12 |