| NPI | 1720223498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 8938459) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6319-15) |
| 122300000X Dentist (Licence: TX 28763) | |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2014-07-29 |