| NPI | 1992765671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD2066) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO H-D-A-04821) |
| 122300000X Dentist (Licence: OK 4344) | |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2007-07-08 |