| NPI | 1871716225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 8902) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3056) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2012-08-06 |