| NPI | 1225136427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23174) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 3593) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-12-05 |