| NPI | 1265467666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 014353) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO Mo. 14353) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2008-08-19 |