| NPI | 1952683724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 6990) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4342) |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2015-01-26 |