| NPI | 1417186891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24975) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX xxxxxxxxxxxxx) |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2013-03-21 |