| NPI | 1902978851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 20517) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 20517) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2008-02-27 |