| NPI | 1154554921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 10083) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 5498321-9921) |
| 1223G0001X Dentist, General Practice (Licence: UT 5498321-8903) | |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2010-02-10 |