| NPI | 1922120757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AL 4225) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 11581) |
| 122300000X Dentist (Licence: NC 5871) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2007-07-08 |