| NPI | 1396158333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 32662) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 2014016152) |
| Enumeration Date | 2014-06-07 |
| Last Update Date | 2022-12-08 |