| NPI | 1982694055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D6706) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 5526) |
| 122300000X Dentist (Licence: FL dn17152) | |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2014-06-21 |