| NPI | 1821307935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33464) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 59873) |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2025-05-08 |