| NPI | 1538268255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 4241) |
| Additional Taxonomies | 122300000X Dentist (Licence: RI den03072) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2010-06-02 |