| NPI | 1174558944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NH 1854) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 1854) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2009-10-21 |