| NPI | 1245382605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 13203) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: DC DEN1000340) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2007-07-08 |