| NPI | 1205387818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34842) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9860) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2019-09-10 |