| NPI | 1780840439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 9943) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 2316) |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2013-06-07 |