| NPI | 1457366023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 17379) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 17379) |
| 1223G0001X Dentist, General Practice (Licence: CA 52544) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2021-06-17 |