| NPI | 1619137833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27858) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AK 1261) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2016-01-21 |