| NPI | 1053643973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI 2400) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 58738) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2010-02-03 |