| NPI | 1609824192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 012299) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 12299) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2011-11-01 |