| NPI | 1770750366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN013759) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN013759) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2011-12-27 |