| NPI | 1881612034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 11983) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 5582) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2009-01-07 |