| NPI | 1528158680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 3651) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: GA 011947) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2015-05-18 |