| NPI | 1982839676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 7384987-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 10174) |
| Enumeration Date | 2009-05-25 |
| Last Update Date | 2013-07-09 |