| NPI | 1649475443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24047) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 5946) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2009-06-02 |