| NPI | 1881663532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2005018812) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN17370) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2009-04-08 |