| NPI | 1467593657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 11544) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 11,544) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2016-02-26 |