| NPI | 1881909893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD3462) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D8066) |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2014-02-04 |