| NPI | 1235228966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D1839) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: AZ D1839) |
| 1223G0001X Dentist, General Practice (Licence: AZ D1839) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |