| NPI | 1356409916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NH 03780) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 017278) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2010-08-04 |