| NPI | 1275742843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 9738345-9921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 18239) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2018-06-27 |