| NPI | 1396836607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WI 2933-015) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MN D9388) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-07-09 |