| NPI | 1437418969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 29743) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 056819) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2021-10-04 |