| NPI | 1962698282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM BD22019) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 25095) |
| 1223G0001X Dentist, General Practice (Licence: AZ D6092) | |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2023-03-09 |