| NPI | 1013959089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AR 4478) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DB2023-0313) |
| 1223G0001X Dentist, General Practice (Licence: TX 15299) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2025-08-22 |