| NPI | 1841501129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 6042) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN014086) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2014-12-07 |