| NPI | 1659589927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 5341-015) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN 10437) |
| 122300000X Dentist (Licence: TX 14145) | |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2007-07-08 |