| NPI | 1437494895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 2246) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00712) |
| 122300000X Dentist (Licence: MN 8098) | |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2012-12-11 |