| NPI | 1366996092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401415281) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 31912) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2021-03-26 |