| NPI | 1083024129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 29820) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401414071) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2024-06-11 |