| NPI | 1679701288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 8896) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 5993) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2011-12-03 |