| NPI | 1780691832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD2286) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 4209) |
| 1223G0001X Dentist, General Practice (Licence: TX 13164) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2014-08-26 |