| NPI | 1427238575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25362) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 56030) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2015-11-03 |