| NPI | 1811942667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D-4037) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2005015021) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2007-07-08 |