| NPI | 1992188932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 94359418903) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 94359419922) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2015-07-08 |