| NPI | 1669477758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 6941) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401008230) |
| 1223G0001X Dentist, General Practice (Licence: MO 012950) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2007-07-08 |