| NPI | 1710185848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 7652072) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AK 1237) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2011-12-15 |