| NPI | 1447486154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27724) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 2354) |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2015-10-01 |