| NPI | 1902113616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 26043) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7433155-9922) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2015-12-10 |