| NPI | 1295990331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 28519) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 054785-1) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2014-09-20 |