| NPI | 1528020914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27782) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 049653) |
| 1223G0001X Dentist, General Practice (Licence: PA DS035474) | |
| 1223G0001X Dentist, General Practice (Licence: PR 2024) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2022-03-02 |