| NPI | 1417035395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 22854) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 22854) |
| 1223G0001X Dentist General Practice (Licence: AR 3526) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-08-28 |