| NPI | 1386874113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 1308) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 7796) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2011-04-11 |