| NPI | 1144773581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 32062) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 7973) |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2025-04-16 |