| NPI | 1174946370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 9419) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN 12439) |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2014-07-07 |