| NPI | 1750669388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6828-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 08865) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2013-06-13 |