| NPI | 1033243803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 40187) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 8158) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2025-03-13 |