| NPI | 1215553565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 38130) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D010719) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2022-04-07 |