| NPI | 1114138369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ 7042) |
| Enumeration Date | 2007-05-26 |
| Last Update Date | 2007-11-30 |