| NPI | 1447522545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 61155) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 61155) |
| 1223G0001X Dentist, General Practice (Licence: TX 32522) | |
| 1223G0001X Dentist, General Practice (Licence: NM DD3724) | |
| 1223G0001X Dentist, General Practice (Licence: TX 27684) | |
| Enumeration Date | 2012-02-04 |
| Last Update Date | 2022-01-06 |