| NPI | 1831347889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 1275) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D9151) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2012-02-15 |