| NPI | 1992714489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 27714) |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: ID D3668) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2021-04-08 |