| NPI | 1093284929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 35577) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 10208) |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2023-11-21 |