| NPI | 1134518293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 9068986-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 9068986-8903) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2015-08-20 |