| NPI | 1023025608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 20559) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 7506) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2023-10-26 |