| NPI | 1326201765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 7190754-9921) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ D7583) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2009-03-03 |