| NPI | 1033665435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 32897) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1857398) |
| Enumeration Date | 2016-08-27 |
| Last Update Date | 2019-02-25 |