| NPI | 1730343724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2004019268) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.028959) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2012-05-31 |