| NPI | 1306022942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 16040) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD1638) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2008-01-14 |