| NPI | 1255479499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 5099) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 5671) |
| 122300000X Dentist (Licence: MO 13385) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2007-07-08 |