| NPI | 1083285506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 12740510-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 37378) |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2022-10-14 |