| NPI | 1366841439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 32613) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 102402) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2024-04-30 |