| NPI | 1326530882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 40070) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 12914788) |
| 1223G0001X Dentist, General Practice (Licence: OK 7210) | |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2024-06-18 |