| NPI | 1780811406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SD D0908) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 08627) |
| Enumeration Date | 2009-06-20 |
| Last Update Date | 2014-03-18 |