| NPI | 1033244371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 16271) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: TX 10761) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2022-07-13 |