| NPI | 1346596509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34727) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: FL DN19703) |
| 1223G0001X Dentist, General Practice (Licence: FL DN19703) | |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2024-01-03 |