| NPI | 1093121006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30882) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DL12175) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2023-03-13 |