| NPI | 1912357351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 10301292-8903) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6841) |
| 122300000X Dentist (Licence: UT 10301292-9922) | |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2017-05-02 |