| NPI | 1093880767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NH 1748) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 14787) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2007-07-08 |