| NPI | 1578700639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26005) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 5738) |
| 1223G0001X Dentist, General Practice (Licence: CA 57145) | |
| 1223G0001X Dentist, General Practice (Licence: NM DD3090) | |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2013-11-27 |