| NPI | 1023342177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PR 2746) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL DN 18167) |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2011-04-26 |