| NPI | 1780705749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1000985) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN013231) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2015-07-14 |