| NPI | 1386845725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PR 2371) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 17231) |
| 1223G0001X Dentist, General Practice (Licence: MD 38613) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2007-07-08 |