| NPI | 1427060920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 32794) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 5342) |
| 1223G0001X Dentist, General Practice (Licence: CA 55297) | |
| 1223G0001X Dentist, General Practice (Licence: MA 21258) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2020-12-24 |