| NPI | 1750391272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D008225) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 21360) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2011-11-03 |