| NPI | 1033251426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 2029) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: SC 2029) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2012-03-16 |