| NPI | 1447458773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KY 8958) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 55863) |
| Enumeration Date | 2007-07-09 |
| Last Update Date | 2011-03-23 |