| NPI | 1134819386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 42471) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2026023679) |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2026-07-20 |