| NPI | 1588870471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 20775) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: TX 20775) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2014-12-08 |