| NPI | 1831121714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26346) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 2710) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2011-03-18 |