| NPI | 1770832297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30352) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 5798098-9922) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2021-01-16 |