| NPI | 1265556195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM 1227) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 11710) |
| Enumeration Date | 2007-03-17 |
| Last Update Date | 2007-07-09 |