| NPI | 1205949633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 22921) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 52537) |
| 122300000X Dentist (Licence: OK 4475) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2007-07-08 |