| NPI | 1336260330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: UT 6425031-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 23645) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2009-06-15 |