| NPI | 1285856906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 31785) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 052651) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2024-03-08 |