| NPI | 1902034119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 7362558-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7362558-9922) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2010-04-21 |