| NPI | 1982836813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6445-015) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 6445-15) |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2011-04-11 |