| NPI | 1336306505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24296) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 50840) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2010-03-09 |