| NPI | 1497732622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 5156) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 106281) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2012-02-09 |