| NPI | 1861436974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ND 2038) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D12224) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2017-04-20 |