| NPI | 1396274031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 36771) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00204580) |
| 122300000X Dentist (Licence: TN 10548) | |
| 122300000X Dentist (Licence: KY 9933) | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2022-03-31 |