| NPI | 1871523985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 18459) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 2798) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2013-09-05 |