| NPI | 1205865375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 59279) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D6461) |
| 1223G0001X Dentist, General Practice (Licence: TX 31516) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2021-01-19 |