| NPI | 1629208897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D008195) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 73594959922) |
| 122300000X Dentist (Licence: MD 14591) | |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2011-06-03 |