| NPI | 1265486161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 6317) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 014337) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2007-11-26 |