| NPI | 1396333027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 36996) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 7157) |
| 1223G0001X Dentist, General Practice (Licence: KY 10512) | |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2024-02-23 |