| NPI | 1326483827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 29276) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 62226) |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2019-02-04 |