| NPI | 1982833497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6478) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN d12720) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2010-01-21 |