| NPI | 1952321614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WV 2380) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MD 13845) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |