| NPI | 1023371945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27898) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6292) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2012-06-20 |