| NPI | 1700099942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23180) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9609) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2008-08-18 |