| NPI | 1356417687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS0000008754) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3586) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2009-04-23 |