| NPI | 1659443117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC DGD4552) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS-028129-L) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2010-03-03 |