| NPI | 1508359761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34105) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 10882) |
| 1223G0001X Dentist, General Practice (Licence: CO DEN.00203718) | |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2018-09-05 |