| NPI | 1295838373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 23151) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AL 5028) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2019-09-18 |