| NPI | 1134260888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 37047) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 37047) |
| 1223G0001X Dentist General Practice (Licence: CA 47227) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2021-03-26 |