| NPI | 1699856732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SD D0623) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9098) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2015-10-26 |