| NPI | 1164974176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33610) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 3234) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2023-12-04 |