| NPI | 1043392319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23749) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21761) |
| 1223G0001X Dentist, General Practice (Licence: GA 13490) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2016-03-05 |