| NPI | 1467439281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401411967) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX T22045) |
| 122300000X Dentist (Licence: MD 14112) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2016-06-29 |