| NPI | 1649477472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN1000087) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401410282) |
| 1223G0001X Dentist, General Practice (Licence: MD 12559) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2007-07-08 |