| NPI | 1669464962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 6213980-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-3756) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2008-09-08 |