| NPI | 1841367273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401412081) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 51081) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2012-11-14 |