| NPI | 1558424051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 40114) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 74837) |
| 122300000X Dentist (Licence: OK 4837) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2010-03-18 |