| NPI | 1871894907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27160) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 27160) |
| Enumeration Date | 2010-11-05 |
| Last Update Date | 2021-03-09 |