| NPI | 1659380012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 30. 017700) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: GA DN010429) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-08 |