| NPI | 1437293305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 8726) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 07177) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2017-04-04 |