| NPI | 1841309986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC PD0589) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3635) |
| 1223G0001X Dentist, General Practice (Licence: GA DN012038) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN012038) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2011-05-11 |