| NPI | 1952303687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 27318) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 2321) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2019-10-03 |