| NPI | 1659499119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 7926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 8033) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2013-01-14 |