| NPI | 1881907475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 7828837) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-4313) |
| Enumeration Date | 2010-07-23 |
| Last Update Date | 2010-12-11 |