| NPI | 1164067153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 41040) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 062411) |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2024-11-30 |