| NPI | 1386950624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 35727) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3903) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2021-01-26 |