| NPI | 1275226763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 39649) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 7727) |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2023-09-12 |