| NPI | 1396928313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901019385) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 5315027426) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2007-12-12 |