| NPI | 1417113960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 41092) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 57368) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2025-11-24 |