| NPI | 1467141408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 42474) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: TX 42474) |
| Enumeration Date | 2023-05-04 |
| Last Update Date | 2026-08-04 |