| NPI | 1700067188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401411836) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 4388) |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2011-04-04 |