| NPI | 1316293848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 28275) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 61670) |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2024-08-02 |