| NPI | 1437369360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 20406) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 5276) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2013-05-06 |