| NPI | 1629181599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 17923) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 53555) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2021-05-26 |