| NPI | 1902061807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 7330714-9921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6058) |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2011-04-14 |