| NPI | 1467829887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 31321) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 32321) |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2021-12-15 |