| NPI | 1437276227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 6940) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ di19268) |
| Enumeration Date | 2007-03-25 |
| Last Update Date | 2018-12-18 |