| NPI | 1740376821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MO 2016011630) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: GA DN010059) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2016-06-02 |