| NPI | 1942287255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 4321) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 7794) |
| 122300000X Dentist (Licence: NC 5357) | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2016-06-07 |