| NPI | 1023080041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 22560) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 2169) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2009-10-01 |