| NPI | 1972722866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 5850-015) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 5850) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2013-10-08 |