| NPI | 1720187727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 10973) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 10973) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2009-07-07 |