| NPI | 1134254808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 014019) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 10325) |
| 1223G0001X Dentist, General Practice (Licence: MI 13767) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2010-12-21 |