| NPI | 1962711606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 25569) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 25569) |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2020-06-16 |