| NPI | 1588861801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 7270) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D9714) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2012-05-14 |