| NPI | 1275077984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34970) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 10135388-9921) |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2024-08-07 |