| NPI | 1528408200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 31940) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 10977) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2016-06-30 |