| NPI | 1861479099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI 1920) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 05528) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2007-07-08 |