| NPI | 1043370331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 21888) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 2025) |
| Enumeration Date | 2006-12-09 |
| Last Update Date | 2007-11-28 |