| NPI | 1710032446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CT 8004) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 8004) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2013-06-11 |