| NPI | 1164904140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34566) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: TX 34566) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2021-06-29 |