| NPI | 1851441802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KY 5843) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 5843) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2015-03-11 |