| NPI | 1063535615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 6990) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH 30-01-7476) |
| 1223G0001X Dentist General Practice (Licence: PA DS022958L) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2016-11-21 |