| NPI | 1881803013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3451-08) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 5794) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2010-06-02 |