| NPI | 1982789699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24135) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 013125) |
| 1223G0001X Dentist, General Practice (Licence: CA 56876) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2021-12-17 |