| NPI | 1699907147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN1000840) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401412512) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2009-08-18 |