| NPI | 1942235296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 5326234 9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 5326234 8903) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2008-10-28 |