| NPI | 1114005386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 11735) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: TX 11735) |
| 122300000X Dentist (Licence: TX 11735) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2026-05-27 |