| NPI | 1629167788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9919) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 1696) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2015-04-13 |