| NPI | 1366037962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 37873) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-5603) |
| 1223G0001X Dentist, General Practice (Licence: UT 13899316-9925) | |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2025-07-28 |