| NPI | 1477953446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30096) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 63450) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2014-08-27 |