| NPI | 1871630293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN012447) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 12447) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2007-07-09 |