| NPI | 1215947122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 20726) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 7647) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2025-04-09 |