| NPI | 1518255363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 29558) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD3536) |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2024-07-29 |