| NPI | 1871744136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 24988) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: TX 24988) |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2010-02-11 |