| NPI | 1952429060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 1429269922) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: UT 1182359920) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2008-02-21 |