| NPI | 1912152190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ND 2095) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D9214) |
| Enumeration Date | 2008-12-01 |
| Last Update Date | 2013-02-18 |