| NPI | 1437179165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25189) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 4798) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2017-02-18 |