| NPI | 1073692836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MS 3496-09) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT 2975) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2011-08-16 |