| NPI | 1255436531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD LL504) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 8379) |
| 122300000X Dentist (Licence: WV 3615) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2007-07-08 |