| NPI | 1649428707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 13735) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 13735) |
| 122400000X Denturist (Licence: MD 13735) | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2010-04-07 |