| NPI | 1356538938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401414390) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 23569) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2024-08-08 |