| NPI | 1487801601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9572) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 4436) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2013-06-27 |