| NPI | 1164584249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25372) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 48435) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2024-03-05 |