| NPI | 1740439843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 08759) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 6295) |
| Enumeration Date | 2008-09-12 |
| Last Update Date | 2010-08-03 |