| NPI | 1306175492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27896) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 59063) |
| Enumeration Date | 2009-12-18 |
| Last Update Date | 2021-01-07 |