| NPI | 1831347665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN014648) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57603) |
| 122300000X Dentist (Licence: AL 5794) | |
| 122300000X Dentist (Licence: TX 26376) | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2013-07-30 |