| NPI | 1982095220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 31704) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 64334) |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2022-04-13 |