| NPI | 1447772280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 33086) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 33086) |
| 1223G0001X Dentist, General Practice (Licence: TX 33086) | |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2024-10-18 |