| NPI | 1285295279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AZ D011608) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 35226) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2022-11-06 |