| NPI | 1043400666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 14405) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.017105) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2007-08-08 |