| NPI | 1205099207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN19579) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX F-24987) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2015-05-21 |