| NPI | 1649381492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WV 3233) |
| Additional Taxonomies | 122300000X Dentist (Licence: WV WV 3233) |
| 1223G0001X Dentist, General Practice (Licence: WV 3233) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2010-07-16 |