| NPI | 1144458019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25262) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 25262) |
| 1223G0001X Dentist, General Practice (Licence: UT 73833819922) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2021-01-05 |