| NPI | 1295823367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 2463295) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AK 1552) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2015-12-10 |