| NPI | 1427236058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 9746) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-4265) |
| 122300000X Dentist (Licence: UT 2774648-9921) | |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2014-02-26 |