| NPI | 1093713299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D8506) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 6994) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2008-05-26 |