| NPI | 1639153711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 2568) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 1223G0001X) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2007-07-08 |