| NPI | 1114213147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL dn 13968) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA dn 17664) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2011-06-28 |