| NPI | 1548329725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 4099) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AK AA532) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2007-07-08 |