| NPI | 1609889187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5970-015) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 0199921) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-07-08 |