| NPI | 1215947973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27584) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 1877) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2012-02-24 |