| NPI | 1386874139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 7670988-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 08672) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2010-07-19 |