| NPI | 1407875727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 3364) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 3416) |
| 122300000X Dentist (Licence: CA 35300) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-07-08 |