| NPI | 1629147681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 275870-9923) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID d-3584) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-07-08 |