| NPI | 1871616201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 9633) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2006015351) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2010-10-26 |