| NPI | 1518391242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 32572) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4008) |
| Enumeration Date | 2013-08-29 |
| Last Update Date | 2021-01-07 |