| NPI | 1669644175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: HI 1952) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 032005) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2008-03-25 |