| NPI | 1447489273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS9240) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 24824) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2015-05-19 |