| NPI | 1891013678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26309) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS038367) |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2019-06-08 |