| NPI | 1609070903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DNO11404) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DNO11306) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2007-07-08 |