| NPI | 1356568273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 5690) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 55434) |
| 1223G0001X Dentist, General Practice (Licence: TX 23163) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2011-12-02 |