| NPI | 1891775003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 7915) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 6565) |
| 1223G0001X Dentist, General Practice (Licence: NC 8123) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2010-09-01 |