| NPI | 1922258789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25843) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN DS0000008920) |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2019-01-10 |