| NPI | 1013012483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 36760) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM 1116) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2021-09-22 |