| NPI | 1831187178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D8874) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 6488) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2008-04-14 |