| NPI | 1033452826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AL C5451) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AL C5451) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2013-04-01 |