| NPI | 1861521759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 8253) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 150553) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2007-07-18 |