| NPI | 1396031506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 8010086-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8010086-9922) |
| Enumeration Date | 2011-06-26 |
| Last Update Date | 2018-07-30 |