| NPI | 1750392833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 49266789922) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 49266788903) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-07-08 |