| NPI | 1245470988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 7352432-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 7223-15) |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2018-07-12 |