| NPI | 1952325193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OR 6181) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AK 662) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2014-11-21 |