| NPI | 1467761494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 35796) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI DT 2410) |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2022-12-19 |