| NPI | 1295830651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 1444899923) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: UT 144489-9923) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2016-02-11 |