| NPI | 1700939196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC NC8913) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 5677) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2014-01-14 |