| NPI | 1992849624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 2905SC) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: SC 2905) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2008-10-29 |