| NPI | 1457469694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 20877) |
| Additional Taxonomies | 1223D0001X Dentist Dental Public Health (Licence: TX 20877) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2018-09-18 |