| NPI | 1831399666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 9402) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6155) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2016-11-27 |