| NPI | 1740341247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AL 311) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 3441) |
| 122300000X Dentist (Licence: GA 7553) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |