| NPI | 1245699974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 35594) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS040878) |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2023-02-26 |