| NPI | 1265522700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NH 1950) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL DN13998) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2007-07-08 |