| NPI | 1720180185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 2845-94) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MS 2845-94) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2011-04-11 |