| NPI | 1841413630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 137627-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 137627-8903) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2007-07-08 |