| NPI | 1144529942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 6133) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7839001-9921) |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2011-03-18 |