| NPI | 1497862056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 4823) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 008818) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2007-07-23 |