| NPI | 1952530644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DNO14143) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN18260) |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2015-06-25 |