| NPI | 1851477996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS 4120) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401008282) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2010-10-14 |