| NPI | 1336394568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 24381) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 57878) |
| Enumeration Date | 2008-12-02 |
| Last Update Date | 2024-06-26 |