| NPI | 1245369172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SD M612) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ND 1745) |
| 1223G0001X Dentist, General Practice (Licence: MN 9305) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2007-07-08 |