| NPI | 1548571409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 27680) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6906) |
| 122300000X Dentist (Licence: MO 2011011989) | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2013-06-26 |