| NPI | 1568688208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 4425) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 8631) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2008-12-14 |