| NPI | 1689823346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 10579) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D7969) |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2012-04-18 |