| NPI | 1871752352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ AZ7490) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 23451) |
| 122300000X Dentist (Licence: AZ 7490) | |
| 122300000X Dentist (Licence: TX TX23451) | |
| 122300000X Dentist (Licence: CA CA59150) | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2011-06-03 |