| NPI | 1528075298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MT 2171) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT 2171) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2017-11-07 |