| NPI | 1972679975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD2877) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 53987) |
| 122300000X Dentist (Licence: TN 8897) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2011-01-05 |