| NPI | 1407071269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CTB-2026-0266) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 11051) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2026-04-20 |