| NPI | 1245470913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 5952) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D7720) |
| 1223G0001X Dentist, General Practice (Licence: CA 58289) | |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2016-02-29 |