| NPI | 1669419701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 6822295) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D3622) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2009-04-16 |