| NPI | 1003411752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 37477) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 37477) |
| 122300000X Dentist (Licence: TX ETN741) | |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2026-02-11 |