| NPI | 1093035842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26425) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 59295) |
| 122300000X Dentist (Licence: TX 26425) | |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2025-08-21 |