| NPI | 1609024777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 8883) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 12479) |
| 1223G0001X Dentist, General Practice (Licence: IL 17579) | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2008-09-03 |