| NPI | 1013368166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 35733) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6689) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2019-11-12 |