| NPI | 1164031431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 40802) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 11703586-9922) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2025-05-13 |