| NPI | 1417935784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 5136779-9922) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 38325) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2023-04-19 |