| NPI | 1427484799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 38246) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63303) |
| 122300000X Dentist (Licence: MO 2013034508) | |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2022-09-02 |