| NPI | 1942427661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ND 1985) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D8157) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2007-08-28 |