| NPI | 1265695159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26098) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 7576) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2010-11-03 |