| NPI | 1700072113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MT 2343) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D7391) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2010-04-01 |