| NPI | 1619181708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 8567) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 6916) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2016-04-14 |