| NPI | 1255310728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23187) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-3771) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2007-07-30 |