| NPI | 1487657011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 11802) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: TX 11802) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2008-09-05 |