| NPI | 1689958514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27351) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 60490) |
| Enumeration Date | 2011-10-11 |
| Last Update Date | 2013-07-11 |