| NPI | 1144355629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 31830) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ 5904) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2021-03-30 |