| NPI | 1063709160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8720) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9070) |
| Enumeration Date | 2011-07-09 |
| Last Update Date | 2016-08-02 |