| NPI | 1336375831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27733) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6817) |
| 1223G0001X Dentist, General Practice (Licence: CO 10108) | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2021-04-29 |