| NPI | 1750516134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 7199) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 51457) |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2014-02-26 |