| NPI | 1346812757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 40074) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1002643-15) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2024-04-03 |