| NPI | 1578786497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA 036615) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA ds036615) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2013-05-08 |