| NPI | 1184769408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DN010769) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH014665) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2007-12-31 |