| NPI | 1295033843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 3104344-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 27894) |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2012-12-09 |