| NPI | 1902102783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 31322) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3367) |
| 1223G0001X Dentist, General Practice (Licence: OK 4025) | |
| 122300000X Dentist (Licence: NY 055446) | |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2015-10-19 |