| NPI | 1316210867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 8043009-9921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 8043009-8903) |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2012-02-14 |