| NPI | 1265432454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26256) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 45761) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2011-11-16 |