| NPI | 1396952495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23149) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 1827) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2024-09-04 |