| NPI | 1629014998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NH 3335) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA 13887) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2007-07-08 |