| NPI | 1013976232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD2705) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 332849) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2022-03-10 |