| NPI | 1306071378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24443) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401416018) |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2023-09-15 |