| NPI | 1396958443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24286) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 9311) |
| 122300000X Dentist (Licence: FL DN17288) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2023-09-29 |