| NPI | 1538239900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SD D0408) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WY WY 946) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2014-07-14 |