| NPI | 1467735092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 40376) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN26666) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2024-05-28 |