| NPI | 1972699379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24123) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 5366) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2009-06-05 |