| NPI | 1003477043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 38285) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6998) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2022-09-22 |