| NPI | 1861819559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 011112) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401414174) |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2014-03-20 |