| NPI | 1427460575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 30876) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9669) |
| 122300000X Dentist (Licence: AZ D009399) | |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2016-04-18 |