| NPI | 1316193857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013676) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9656) |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2011-12-18 |