| NPI | 1881726560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 6799) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 6027) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2009-04-14 |