| NPI | 1336117803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KY 7459) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MD 6001) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2007-07-08 |