| NPI | 1932309275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 22725) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 5853) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2020-09-16 |