| NPI | 1326664996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 36209) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 36209) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2022-08-15 |