| NPI | 1689752008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA D5025735L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA Ds025735L) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2016-05-18 |