| NPI | 1215500251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 38376) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 106617) |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2022-08-19 |