| NPI | 1154594448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DC 5225) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS039367) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2018-11-16 |