| NPI | 1174141113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 40253) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN25125) |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2024-01-31 |