| NPI | 1447239827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 22652) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS035534) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2010-07-16 |