| NPI | 1598959082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D8984) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D07904) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2014-09-05 |