| NPI | 1063021723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 36435) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 25046) |
| 1223G0001X Dentist, General Practice (Licence: TX 36435) | |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2021-10-21 |