| NPI | 1285420406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 41977) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 9407238-9926) |
| Enumeration Date | 2025-04-15 |
| Last Update Date | 2025-09-19 |