| NPI | 1982987608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 5501438-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 5501438-8903) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2011-09-20 |