| NPI | 1831130178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MO 014721) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 29636) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2007-07-08 |