| NPI | 1225258353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 9004) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD1875) |
| 122300000X Dentist (Licence: MO 013544) | |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2007-07-08 |