| NPI | 1386734259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25949) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 3263) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2011-08-02 |