| NPI | 1932380250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401411820) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9535) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2008-10-24 |