| NPI | 1184389454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 39294) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD5552) |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2024-12-11 |