| NPI | 1184911240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 101235) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 27453) |
| 122300000X Dentist (Licence: WI 6775-15) | |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2022-10-14 |