| NPI | 1346688256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34266) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD3885) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2019-12-31 |