| NPI | 1992843213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NE 5223) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 13778) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2012-09-05 |