| NPI | 1245365550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 23212) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D7067) |
| 122300000X Dentist (Licence: CA 42326) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2010-05-07 |