| NPI | 1073673752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 17266) |
| Additional Taxonomies | 1223D0001X Dentist Dental Public Health (Licence: TX 17266) |
| 1223G0001X Dentist General Practice (Licence: TX 17266) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2024-10-07 |