| NPI | 1760496111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401411342) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 7773) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2011-11-29 |