| NPI | 1306993191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 4965) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 22986) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2014-02-19 |