| NPI | 1144405390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 6824) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 3431-07) |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2017-08-25 |