| NPI | 1144459108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 58405) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD3252) |
| 1223G0001X Dentist, General Practice (Licence: TX 25671) | |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2014-08-11 |