| NPI | 1992896799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 7026) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 4545) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2012-02-14 |