| NPI | 1164295051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 40145) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 40145) |
| 122300000X Dentist (Licence: TX 40145) | |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2025-11-20 |