| NPI | 1801124862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 014064) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 4155) |
| Enumeration Date | 2009-12-01 |
| Last Update Date | 2012-10-25 |