| NPI | 1518199629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DN015074) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 4655) |
| Enumeration Date | 2009-08-23 |
| Last Update Date | 2015-10-10 |