| NPI | 1922289446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2012040676) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN17846) |
| 122300000X Dentist (Licence: KS 60958) | |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2013-07-01 |