| NPI | 1265707483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 202339) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8325976-9921) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2016-01-26 |