| NPI | 1487998423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 82597181-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8259781-8903) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2016-10-28 |