| NPI | 1053481267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 4715) |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2007-07-08 |