| NPI | 1730555319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 31366) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN21486) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2015-08-18 |