| NPI | 1386840106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 39204) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 7091) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2023-05-10 |