| NPI | 1447452503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OR 9078) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 2219) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2008-06-13 |