| NPI | 1437475019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 29406) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 59173) |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2016-07-13 |