| NPI | 1699849935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 6133) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: AZ 6133) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2007-07-08 |