| NPI | 1770701377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9606) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401006610) |
| Enumeration Date | 2007-04-22 |
| Last Update Date | 2014-12-17 |