| NPI | 1184914616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D008489) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 9019671-9921) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2016-03-15 |