| NPI | 1598896524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC DN011106) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN13417) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2008-05-29 |