| NPI | 1255841094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 38074) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 101717) |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2022-02-03 |