| NPI | 1568422525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 7107) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 1862) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2013-06-03 |