| NPI | 1093994790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2012034575) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 23592) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2013-07-02 |