| NPI | 1003999707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 19485) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 13322) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2022-01-21 |