| NPI | 1851555635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC DGD 7111) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN013739) |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2013-03-20 |