| NPI | 1306338801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 39068) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204156) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2023-08-29 |