| NPI | 1447570403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 8414288) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 25409) |
| 1223G0001X Dentist, General Practice (Licence: UT 8414288-9922) | |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2024-08-21 |