| NPI | 1386098606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 36107) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 100301) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2020-09-15 |