| NPI | 1760571897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901012346) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D3358) |
| 122300000X Dentist (Licence: UT 1414579921) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |