| NPI | 1689607517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: LA 2679) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 9568) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-07-08 |