| NPI | 1952558835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 8847) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 4497) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2010-09-28 |