| NPI | 1508272915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 9236046-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00202233) |
| 1223G0001X Dentist, General Practice (Licence: TX 33749) | |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2019-11-21 |