| NPI | 1871534032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 7855) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3974) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2011-07-14 |