| NPI | 1609002088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN 3288) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 6399) |
| Enumeration Date | 2009-05-30 |
| Last Update Date | 2009-05-30 |