| NPI | 1740485234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 5505) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9406) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2009-05-19 |