| NPI | 1518214428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 28585) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD3746) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2021-11-22 |